Disability: The Understudied Population in Orthopaedics

Healthcare disparities profoundly affect healthcare delivery. Patients with disabilities remain under-recognized as a population warranting focused public health attention. The purpose of this systematic review was to identify and characterize published literature addressing access to or outcomes of orthopaedic care among people with disabilities. This study received IRB exemption. Articles published within the past five years in the top 20 highest impact factor (IF), Medline-indexed American orthopaedic surgery journals were identified through PubMed. Studies assessing access to or outcomes of orthopaedic care among underserved populations were included. Two reviewers independently screened abstracts and full-text articles and extracted data, with discrepancies resolved by consensus. A total of 124 manuscripts met the inclusion criteria. Of these, 61 (49.2%) only examined disparities in access, 36 (29.0%) examined disparities in outcomes, and 27 (21.8%) examined disparities in both access and outcomes. Commonly evaluated disparity-related factors were race (53.2% of outcomes studies and 32.6% of access studies), insurance/payor status (29.0% outcomes and 39.3% access), socioeconomic factors (45.2% outcomes and 28.1% access), ethnicity (33.9% outcomes and 19.1% access), and presence of chronic illnesses (35.5% outcomes and 30.3% access). Barriers to orthopaedic care access or orthopaedic outcomes related to disability were examined less often than those related to other underserved populations, in only 6 (5.0%) of all studies. There remains a critical gap in the orthopaedic literature regarding access to care and outcome disparities among patients with disabilities. Future research should systematically evaluate barriers faced by this population and incorporate inclusive design principles to promote equitable orthopaedic care.